Provider Demographics
NPI:1952490377
Name:MACINNIS, LAVERNE V (LCMHC)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:V
Last Name:MACINNIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CYPRESS ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-668-4079
Mailing Address - Fax:
Practice Address - Street 1:445 CYPRESS ST STE 8
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-668-4079
Practice Address - Fax:603-663-8605
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional